Should the Federal Government Cover the Costs of Births?

Healthcare is expensive. Debates about reducing healthcare costs are perennial, with a seemingly endless supply of proposals. Last July, Elizabeth Bruenig of The Atlantic provocatively proposed that Americans – especially those in the Pro-Life movement – should “agree that pregnancy, childbirth, and postpartum care should all be free, and demand that the federal government make it so.”

Variations of Bruenig’s proposal have circulated in subsequent months, and on April 25^th, The Institute for Human Ecology at the Catholic University of America hosted a panel discussion titled “Should Birth Be Free?” Matthew Walther , editor of The Lamp, moderated the discussion. Tom Shakeley, Chief Engagement Officer at Americans United for Life (AUL), argued in favor of government-funded birth. AUL has published suggestions for how Congress could take steps to eliminate the costs of births for American families. Washington Post columnist Megan McArdle was skeptical of the efficacy of such a program.

Shakeley – who referenced Bruenig’s piece multiple times during the panel – began his argument with an emphasis on community, suggesting that birth is not an abstract concept; rather, babies are human persons born into particular families and communities.

According to Shakeley, eliminating the medical cost of births “is a way to strengthen our social fabric, not just for families, but for our whole country.” Shakeley believes the inherent goodness of birth for both families and society at large needs to be emphasized, especially amidst post-Dobbs debates about abortion. He suggested that publicly funding births would help change public opinion on these topics and provide a “substantive” Pro-Life policy. Shakeley also highlighted the threat of depopulation as a reason for supporting such a policy, as well as the potential GDP benefits of more children in the United States.

While Shakeley’s arguments were optimistically philosophical, McArdle’s were more pragmatic. McArdle noted agreement with Shakeley on various points but ultimately disagreed on the benefits of government-funded birth.

“I don’t think that making birth free solves any particular problem,” McArdle said, characterizing such a policy as primarily symbolic. She noted that many births are already government-funded through Medicaid, and stated her belief that medical insurance should “cover expenses that most people don’t have,” which would exclude births.

McArdle also suggested families could still have to pay birth costs through taxes or insurance premiums. “Someone’s got to pay for it one way or other, and that someone is going to be, by and large, the same people who are having the babies.”

Moving to larger scale issues, McArdle noted the tenuous long-term status of other government programs like Social Security and stated that covering birth expenses “adds a burden onto the government when the government is not yet prepared to finance the burdens that it’s already taken on.”

Shakeley countered that funding births would only add $40-50 billion to the annual federal budget, a small percentage of federal healthcare spending. McArdle granted this point, but still expressed concerns about adding even marginal spending. She expressed further concerns about excess government involvement in healthcare, citing logistical issues revealed by the implementation of the Affordable Care Act.

McArdle also spoke against Shakeley’s belief that government-funded births would encourage Americans to have more children, suggesting there are other reasons for decreasing birth rates in recent years. She suggested that there is little evidence that these other, mostly cultural, reasons for low birth rates would be aided much by government programs which “give people big chunks of cash for having kids.”

Shakeley responded by citing examples of government policies changing society, noting the impact of the interstate system and public schools. He also expanded on his previous comments regarding societal goods, suggesting that making births free would promote the common good just as previous policies had.

In response to an audience question pushing her on the role of the government, McArdle noted that the government can affect culture. She reiterated that she did not believe government-funded birth would notably affect culture. 

McArdle also cited anecdotal evidence to support her position: “When I talk to people in their 20s who are delaying marriage and family, the cost of giving birth has, I think, literally never come up.”

Both Shakeley and McArdle presented compelling points supporting their respective positions, and their discussion highlighted various key philosophical and economic factors surrounding debates about whether birth should be free for families – factors which conservative or conservative-leaning people may disagree about (McArdle mostly referred to herself as a libertarian, but often expressed socially conservative personal views). In the still-young post-Dobbs world, the Pro-Life movement has much to consider and debate about how best to support the preservation and flourishing of human life.